Academic Ceremonies September 2014

“Epidemiology of pancreatic cancer: a global approach”

Wednesday 3 September 2014, 12.00 hours

“Clinical aspects of irritable bowel syndrome, with a special focus on visceral hypersensitivity and intestinal permeability”

“Formal and informal patient payments for public health care services in Bulgaria”

“Endoscopic treatment of obesity and metabolic disorder; Basic and Clinical studies on the effect of the Duodenal-Jejunal Bypass Liner”

The number of people who are overweight is increasing rapidly, as is the number of diseases associated with overweight such as diabetes and fatty liver disease. Weight loss surgery has been performed as a treatment for severely overweight individuals for many years. Recent research into less invasive techniques resulted in the Duodenal-Jejunal Bypass Liner (DJBL). This involves placing a flexible Teflon tube in the small intestine, just beyond the stomach, using laparoscopic surgery. This tube separates the flow of food from the digestive juices, thus delaying digestion. The DJBL is a highly promising technique: the study showed that patients treated with this technique lost weight and that their diabetes and fatty liver disease improved.

“Prevention of passive smoke exposure in children with a high risk of asthma”

“Protecting pre-license teens from road risk; Identifying Risk-contributing factors and quantifying effects of intervention Strategies”

Young people, and males in particular, die almost as often as a result of non-natural causes such as road traffic accidents as they do from diseases. This thesis shows that giving demonstrations or teaching basic rules of thumb as part of road safety education programmes does not prepare young adolescents (10–17 years of age) adequately for complex and dangerous road traffic situations. It is important for young people to practice in those situations in order to gain more experience, for example with a lorry’s blind spot. Moreover, it has been shown that short-term educational programmes, irrespective of whether they focus on promoting insight or fear, are less effective than originally thought.

Key words:

road safety, adolescents, education

“Hoe populaties personen worden”

“Modeling Non-Stationary and Stationary Mixed-Frequency Time Series”

The general public is continuously made aware of rising or falling future GDP growth rates, industrial production indices, unemployment rates, real wages and so on. The construction of these predictions, which are regularly done by central banks or research institutions, is usually based on the combination of various forecasts obtained using a large set of models. This dissertation fills two gaps in the mixed-frequency literature by introducing, applying and analyzing extensions of the Mixed Data Sampling (MIDAS) approach and mixed-frequency vector autoregressive models (VAR) to the non-stationary case on the one hand and by investigating causality testing within (large-dimensional) mixed-frequency VAR models on the other hand. The results of this thesis allow researchers to make more precise predictions of (non-stationary) time series such as GDP using predictors of potentially different frequencies.

Key words:

Econometrics, MIDAS, Mixed-Frequency, Time Series 

“Female Return Migration and Reintegration Strategies In Ethiopia”

“Macrophage polarization in atherosclerosis; from a black and white paradigm to a multicolored view”

Atherosclerosis, or hardening of the arteries, is a chronic inflammatory disease of the blood vessel wall and is the underlying cause of cardiovascular disorders such as myocardial infarction and stroke. It has been shown that macrophages (inflammatory cells) play an important role in the development and growth of plaques associated with the atherosclerotic process.
This doctoral research study examined the role of various subtypes of macrophages in atherosclerosis. There are two main subtypes: M1 macrophages encourage inflammation and are therefore assumed to worsen atherosclerosis, and M2 macrophages decrease inflammation and are therefore thought to slow down atherosclerosis.
We can thus conclude that macrophage polarisation plays an important role in the development of atherosclerotic plaque. It was shown that systemic M2 macrophage polarisation in mice treated with antigens from parasitic worms significantly reduces the growth of plaque in mice. These antigens could potentially be used in the future to slow down atherosclerosis.

Key words:

atherosclerosis, macrophages

“Information Disclosure: theory, policy and experiment”

“Instilling a thirst for learning; understanding the role of proactive feedback- and help seeking in stimulating workplace learning”

This thesis describes research on two important aspects of proactive learning behaviour: feedback-seeking behaviour and help-seeking behaviour. The results highlight the importance of promoting a psychologically safe working environment in which staff learning is stimulated and staff ask each other for feedback and help. Results show that supervisory staff play an important role, and that the quality of the feedback and help in particular is essential to performance. Moreover, the findings highlight the importance of investing in relationships and maintaining the accessibility of expertise. The challenge for organisations is to create a safe working environment that supports feedback-seeking and help-seeking behaviour. 

Key words:

learning, feedback, workplace, networking

“Health technology assessment of diagnostic strategies for Alzheimer’s disease”

People are trying to predict Alzheimer’s disease increasingly earlier. This thesis examines whether CSF diagnostics, applied in a decision algorithm, can improve the predictability of developing Alzheimer’s disease. This algorithm had no added value compared with established diagnostic practice.  It is possible that in the future, drugs may become available that slow down the progress of Alzheimer’s disease. Various scenarios were developed using a simulation model. This showed that a lumbar puncture can effectively help select patients that would benefit from this kind of hypothetical new drug.  The results of this study provide pointers to help better focus the diagnostics for Alzheimer’s disease.

Trefwoorden:

Alzheimer, dementie, cognitieve stoornis, diagnostiek, economische evaluatie, doelmatigheid, kosten-effectiviteit

“Cardiac Resynchornization therapy : maximizing benefits with minimal efforts"

“Clinical Optimization in Liver Surgery"

“Verwantschap weven : vertelpraktijken en culturele herinnering in transnationale adoptie”

“Vaccinating: self-evident or not ?; Development of a monitoring system to evaluate acceptance of the National Immunization Program”

This thesis describes the factors affecting parents’ decisions on immunising their children through the National Immunisation Programme in the Netherlands (RVP), and the experiences of child health care centre workers with the RVP. Attitude plays an important role in the parents’ decision regarding immunisation.  Most parents (81%) consider immunising their child within the RVP to be a matter of course. Child health care centre workers are satisfied with the way the RVP is currently organised. Some staff avoid any discussion with parents about the RVP, mainly due to a lack of time. Furthermore, we analysed messages placed on the Internet during the measles outbreak because this can serve as a consistent and quick source of information about people’s attitudes towards immunisation. All these various studies have resulted in a system being set up to monitor the acceptance of RVP among parents and child health care centre workers.

Key words:

National Immunisation Programme in the Netherlands, acceptance, parents

“Learning in Urology; designing simulator based skills; Training & Assessment”

Following the example set by the field of aviation, medicine is giving increasing attention to the use of simulation training, and also for surgical skills training. This thesis describes how simulators for learning surgical skills can be tested for reliability (validation) and how training using simulators can be structurally developed. In this project, and in collaboration with the urology department at Catharina Ziekenhuis Eindhoven and Radboud University Medical Centre, the ‘Program for Laparoscopic Urological Skils’ (PLUS) was developed and validated for the standardisation of basic laparoscopy skills for trainee urologists. On the basis of this study, the PLUS assessment has now been implemented as an obligatory examination for urology training in the Netherlands, and by the European Association of Urology as the Basic Laparoscopic Urological Skills exam. 

Key words:

simulation training, laparoscopy, urology

“Regulatory T cells in the pathogenesis of Multiple Sclerosis: potential targets for vitamin D therapy”

Multiple sclerosis (MS) is regarded as an immune disorder in which the immune system attacks the body’s own tissues and causes chronic inflammation of the brain. The exact cause of MS is unclear.  Both hereditary and environmental factors appear to play a role in developing one’s susceptibility to MS. In this study, we examined the population of T-cells, important immune cells, in the blood of MS patients and showed these to feature several defects.  We also showed that vitamin D, which is made in the skin under the influence of sunlight, has the ability to correct some of the defects in the T-cell population. Further research is required to determine whether vitamin D could be used in the treatment of MS.

Key words:

Multiple sclerosis (MS), treatment, T-cell population, vitamin D

“When is migration a security issue?”

“Light my Fire; leven buiten de comfort zone”

“Competentiegericht opleiden en toetsen”

“Cell-based therapy for hypoxic-ischemic injury in the 
preterm brain”

Brain damage due to oxygen deficiency is common in premature babies. Unfortunately, there is no therapy with which to treat this damage. In this thesis, a model that very accurately imitates brain development in premature babies shows that stem cell therapy is effective in reducing damage in the immature brain as a result of oxygen deficiency.  This innovative experimental study will form the basis for future clinical studies examining the suitability of stem cell therapy in the treatment of brain damage in premature babies. These studies may help us to improve the quality of life for many children born prematurely with brain damage.

Key words:

Brain damage in premature birth, stem cell therapy

“Towards consistency of EU external policies? A Case Study on the European Commission”

The European Union deploys a multifaceted external action through its trade policy, development cooperation and its foreign policy notably. The coordination of these different activities challenges the capacity of the EU and of individual institutions to deliver a consistent message. Examining the Treaty, legal and decision-making instruments to ensure consistency, this dissertation focused on the European Commission’s capacity to coordinate EU external policies. In a changing political, institutional and legal context, the Commission has coped with a renewed coordination challenge. Facing internal and external pressures, its decision-making has evolved to counter the risk of inconsistency of its policy output.

Key words:

EU, external policies

“Exposure to antenatal inflammation – mechanisms of fetal adaption”

"Nutrition Economics Disease related malnutrition & the economic healthcare value of medical nutrition"

Disease related malnutrition is still highly prevalent in the Western world, and that also applies for the Netherlands. However, this ‘silent killer’, as it were, is not as clearly recognisable as the other major diet-related health problem of overweight/obesity, with all its consequences, including high health care costs. 
This thesis shows that disease-related malnutrition in adults and the elderly is already costing the Dutch health care system 1.9 billion euros annually, and this does not include the costs for children. Health economics calculations have shown that millions of euros can be saved on health care by treating patients correctly. Optimum nutrition plays a crucial role in this respect.
Finally, ‘nutrition economics’ is described as a relevant new area within the long established field of Health Economics. The general discussion includes an overview of the methodological challenges and the subsequent recommendations for nutrition economics practice and future research.

Key words:

disease related malnutrition, costs, nutrition economics

“Opoe op bezoek”

“Prognosis of Chronic Clinical Pain Conditions: The Example of Complex Regional Pain Syndrome 1 and Low Back Pain”

This thesis contributes important new evidence to three main areas of patient-centered care for non-specific low back pain and CRPS 1.
First it is shown that fear is a potentially modifiable psychological factor that influences both the prognosis and treatment success in patients with persistent low back pain. Fear may lead to fear of activity and avoidance, which leads to disuse and distress and results in a deleterious cycle.  Second a first systematic analysis of prognostic factors in patients with CRPS 1 was done, but more research is needed to fully identify early indicators of the course of CRPS 1.
Third it is shown that in randomized controlled trials for low back pain on average, only 50% of the known prognostic factors were reported. Therefore, all stakeholders should support a collaborative effort to obtain a consensus on disease definitions and outcomes, in an effort to support the collection of high quality data for patients with chronic pain conditions.

Key words:

chronic pain, non-specifik low back pain, CRPS 1

“Eye on Innovation”

Friday 26 September 16.30 hours

“An experimental model of Huntington’s disease: Validation & Stimulation”